Distributing and Developing Social Resources: A Latino

Immigrant Community lntervention

Mark Edberg, PhD* CLIHD Center Director

George Washington University[*Many faculty/staff/community staff

contributed to this presentation]

Collaborative Center on Latino Immigrant/Refugee Health Disparities

• The Center is a collaboration between GWU and key groups within the Latino community of Langley Park, MD to address the co-occurrence of substance abuse, violence and sex risk among youth – a significant health disparity – through an intervention, mutual capacity building and community engagement.

• The intervention component is called ADELANTE

Community Background: Langley Park, MD

• Residents primarily from El Salvador and Guatemala, with significant populations from Honduras, Nicaragua, and to a much lesser extent Mexico and Caribbean.

• Most of original immigrant community fled to the U.S. during and after the Central American civil wars of the 1980s. More recent immigrants here for economic reasons.

• Because of Cold War the politics involved in these civil wars, most of the original refugees could not apply for refugee status.

Community Background (cont’d)• Limited assistance was available from government refugee

programs, community was marginalized and without much help right from the beginning.

• Without refugee status, issues of documentation and legality part of the “community dilemma” – exacerbated by recent politics.

• For a long time, only limited services available in Langley Park, primarily provided by NGOs, faith community, plus some from County. Situation now improving due to a County initiative (Transforming Neighborhoods).

Community Background (cont’d)

• Target health issue context: In recent years, violence levels (youth and gang violence, partner violence) high, substance abuse, school dropout, family conflict, poverty, and other health risks prevalent – as health disparities.

• Our previous CDC-funded intervention called SAFER Latinos (focus on youth violence) was based on a model of four contributing factor domains: family cohesion issues, school barriers, community fragmentation/low efficacy/low service access, and violence attitudes and practices connected to gang presence.

New Intervention Framework

• Based on previous (intervention) collaboration with community groups, it was viewed as important to develop an intervention that addressed factors at multiple levels in the community, tailored to Latino immigrant circumstances.

• Decided on a Positive Youth Development (PYD) theoretical framework, emphasizing the person-environment relationship, on “marshaling community resources” to build supportive resources among individuals and community institutions – correlated with reduction in health risks.

New Intervention Framework• PYD in keeping with a social-ecological model assuming that

social/health problems are the outcome of interacting contributing factors at multiple levels – individual, family and social group, community, culture, economic, and so on, as a kind of “system” that produces “clusters of vulnerability.” Addressing just one level is rarely enough.

• PYD is a relatively new approach. Necessary to tailor constructs and evaluation protocol to Latino immigrant community.

• From previous SAFER Latinos data, the vulnerability cluster for youth: substance abuse, violence and sex risk co-occurring as syndemic conditions.

PYD Constructs

PYD has been operationalized as “Five Cs” of positive youth development (* constructs used for the intervention): • Competence*• Confidence*• Connection*• Character• Caring

Together, these constitute “thriving”, and a 6th C, contribution*, or contributions to self, to family, to community, and to the institutions of civil society

PYD Model

ADELANTE Multi-Level Intervention

• Universal/Community-Wide Components: Recreation coupled with prevention modules; job skills development; youth advocacy training and youth media; tutoring and academic support; high school peer advocates and school activities; parent (bicultural) capacity building; community engagement activities (e.g., health literacy, program identity).

• Additional Targeted High Risk Components: For selected youth and families already at high risk – youth/family case management, family dinners, youth-family support.

• Drop-in Center services supporting community-wide and high-risk components.

ADELANTE Multi-Level Intervention

ADELANTE Multi-Level Intervention

Intervention TimelineMonth

April

May

June

July

Aug

Sept

Oct

Nov

Dec

Evaluating ADELANTE• Community Survey – At baseline and in Years 3 and 4, in

both intervention and a comparison community in Virginia (Culmore). Survey in Spanish or English, assesses PYD and other mediating constructs, demographics, attitude, knowledge and behavior outcomes. N=1200 each wave.

• High-Risk Cohort Survey – For recruited cohort members and parents, at baseline Years 1 and 2 for each cohort (two cohorts, 150 each). Similar to community survey, with some variation. Done with AUDIO-CASI.

• Process and Focus Group Data – Track community participation in activities, assess cohort experience with case management.

• Latino immigrant health disparities symposium on May 22 – bringing together area stakeholders.

• Continued intervention “rollout.”• Recruitment and implementation of high risk

components.• Intervention identity (“brand”) finalized, along with

characters and narrative that could be used to help involve youth and community members

• Implementation of activities to involve students in community work, involve community members in educating university (students, faculty) on Latino health disparities.

Upcoming…